We’ll guide you through a few simple steps, so your first visit feels focused, thoughtful, and prepared. You can keep things simple—nothing needs to be perfect.
This is simply the first step—we’ll review everything and guide you from here. You don’t need to have everything figured out—just share what you can. If you have questions or would prefer to share this information verbally with Dr. Epple, we are always happy to help.
Membership is designed for patients who want a more continuous relationship with their physician, predictable monthly care costs, and ongoing support for prevention, wellness goals, and health concerns over time.
I understand membership is not active until my enrollment information, required paperwork, and payment setup have been reviewed and accepted by the practice.*
I understand that non-member visits are billed per visit at the non-member rate and do not include ongoing membership benefits.
*Virtual visits are available for patients physically located in Missouri at the time of the visit.
It is optional to provide your medical conditions at this time.
I understand this form is a request for care, not a medical visit, and does not establish a physician–patient relationship. I agree to provide accurate information and understand my information will be handled according to the practice’s privacy policies. For emergencies, I will call 911 or go to the nearest ER.*
I agree to the Privacy Policy and understand that this form is for initial communication only.*
